Provider Demographics
NPI:1386842128
Name:MARTIN SAMUELS, SONIA E (DDS)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:E
Last Name:MARTIN SAMUELS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12164 CENTRAL AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721
Mailing Address - Country:US
Mailing Address - Phone:301-249-4404
Mailing Address - Fax:301-249-2209
Practice Address - Street 1:12164 CENTRAL AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721
Practice Address - Country:US
Practice Address - Phone:301-249-4404
Practice Address - Fax:301-249-2209
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10653122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist